PYK Payment Receipt Booklet

15 DETAILS OF DEPENDENT CHILDREN Is the Dependent Child / Children covered in terms of other policies? Important: See Membership Terms and Conditions Booklet for the definition of a Dependant * ID Numbers are required. Control Number SC ID Number* Name and Surname Male/ Female Date of Birth Biological Child Signature of Church Official 1 2 3 4 5 6 7 8 9 10 Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N NY